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Efficacy and safety of various endosurgical procedures for management of large renal stone: a systemic review and network meta-analysis of randomised control trials

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Abstract

Urolithiasis is the most common benign urological health condition. It has contributed sizeable burden of morbidity, disability, and medical health expenditure worldwide. There is limited high level of evidence on the efficacy and safety of treatment options of large renal stones. This network meta-analysis has examined the effectiveness and safety of various large renal stone management strategies. Systematic review and network meta-analysis (NMA) study design was employed to summarize comparative randomized controlled trials on humans with a diagnosis of renal stone larger than or equal to 2 cm in size. Our searching strategy was based on the Population, Interventions, Comparison, Outcomes, and Study (PICOS) approach. Medline via PubMed, Embase, Google scholar, SCOPUS, Science Direct, Cochrane library, Web of Science, and ClinicalTrials.gov were searched from inception to March 2023 to find eligible articles. Data extraction, screening, selection and risk of bias assessment were conducted by two independent reviewers. We found ten randomised control trials which consists 2917 patients, nine of them were labeled as low risk and one article was high risk. This network meta-analysis found that SFR was 86% (95% CI 84–88%) for Mini-PCNL, 86% (95% CI 84–88%) for standard PCNL, 79% (95% CI:73–86%) for RIRS, and 67% (95%CI:49–81 for staged URS for management of large renal stone. Overall complication rate was 32% (95% CI 27–38%) for standard PCNL, 16% (95% CI 12–21%) for Mini-PCNL, and 11% (95% CI 7–16%) for RIRS. Mini-PCNL (RR = 1.14 (95% CI 1.01–1.27) and PCNL (RR = 1.13 (95% CI 1.01–1.27)) were statistically associated with a higher SFR compared to RIRS. The pooled mean hospital stays were 1.56 days (95% CI 0.93–2.19) for RIRS, 2.96 days (95% CI 1.78–4.14) for Mini-PCNL, 3.9 days (95% CI 2.9–4.83) for standard PCNL, and 3.66 (95% CI 1.13–6.2) for staged URS. Mini-PCNL and standard PCNL were the most effective treatment options with significant morbidity and length of hospital stay, while RIRS was the safest management option with acceptable SFR, low morbidity, and short hospital stay.

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Data availability

The dataset generated and analyzed during the current study are available from the corrsponding author on reasonable request.

Abbreviations

PCNL:

Percutaneous nephrolithotomy

m-PCNL:

Mini-percutaneous nephrolithotomy

RIRS:

Retrograde intrarenal surgery

SFR:

Stone free rate

MD:

Mean difference

RR:

Relative risk

RCT:

Randomised control trial

BPH:

Benign prostate hyperplasia

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  1. Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia

    Atalel Fentahun Awedew, Chalachew Tenna Alemu & Dawit Zerihun Yalew

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Concept note development and draft AF. Protocol development AF, DZ, CT. Searching, screening, and selection AF, DZ, CT. Risk assessment and data extraction AF, DZ, CT. Data analysis AF. Manuscript writing, editing and review AF, DZ, CT.

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Awedew, A.F., Alemu, C.T. & Yalew, D.Z. Efficacy and safety of various endosurgical procedures for management of large renal stone: a systemic review and network meta-analysis of randomised control trials. Urolithiasis 51, 87 (2023). https://doi.org/10.1007/s00240-023-01459-x

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